双肛管预防腹腔镜中低位直肠癌术后吻合口漏

Prevention effect of anastomotic leakage by the innovative double transanal drainage tubes after laparo-scopic anterior resection of mid-low rectal carcinoma

目的探讨自制多侧孔并列双肛管预防腹腔镜中低位直肠癌前切除术后吻合口漏的安全性和有效性。方法回顾性分析2019年1月至2022年3月株洲市中心医院250例腹腔镜中低位直肠癌患者的临床资料。根据术后留置肛管类型分为自制多侧孔并列双肛管组(研究组,131例)和单肛管组(对照组,119例)。比较两组患者术后C级吻合口漏发生率、术后肛管首次引流时间、首次肛门排气排便时间,术后肛门疼痛及腹胀程度等。研究的主要终点是术后30 d内C级吻合口漏,次要终点是肛门术后疼痛评分和肛管相关性不良事件,如出血和医源性结肠穿孔。结果术后发生C级吻合口漏13例(5.20%),其中研究组3例(2.29%),对照组10例(8.40%)。研究组患者在C级吻合口漏发生率、肛管引流时间、首次排气时间和首次排便时间上均优于对照组(P<0.05),而在腹腔引流管放置时间、手术后住院时间、手术后肛门疼痛评分、腹胀评分和肛管脱落率等方面,两组比较均无显著差异(P>0.05)。两组均未发生与肛管相关的吻合口出血和肠穿孔等不良事件。结论自制多侧孔并列双肛管是安全有效的,能降低腹腔镜中低位直肠癌前切除术后的吻合口漏发生率。

Objective To investigate the safety and effectiveness of double parallel self-made multiple side holes transanal drainage tubes in preventing anastomotic leakage after laparoscopic anterior resection(LAR)for mid-low rectal cancer patients.Methods A retrospective analysis was conducted on the clinical data of 250 patients with mid-low rectal cancer undergoing LAR at Zhuzhou Central Hospital from January 2019 to March 2022.According to the type of transanal drainage tubes,they were divided into two groups:The double parallel self-made multiple side holes transanal drainage tubes group(the observation group,131 cases)and the single transanal drainage tube group(the control group,119 cases).It was compared of the postoperative C-grade anastomotic leakage rate,the first postoperative transanal drainage time,the first exhaust and defecation time,postoperative anal pain and abdominal distension score between two groups.The study's primary endpoint was the incidence of C-grade anastomotic leakage within 30 days after surgery,while the secondary endpoints were postoperative pain scores and adverse events related to the transanal drainage tubes,such as bleeding and iatrogenic colon perforation.Results There were 13 cases(5.20%)of postoperative C-grade anastomotic leakage,including 3 cases(2.29%)in the observation group and 10 cases(8.40%)in the control group.The observation group showed better results in C-grade anastomotic leakage rate,the first postoperative anal drainage time,the first exhaust time,and the first defecation time(P<0.05).However,there was no sig-nificant difference in terms of abdominal drainage tube placement time,postoperative hospitalization time,post-operative anal pain,abdominal distension score and transanal drainage tube detachment rate(P>0.05).There were no adverse events such as anastomotic bleeding or colon perforation related to the transanal drainage tube in both groups.Conclusions It is safe and effective to use double parallel self-made multiple side holes transanal drainage tubes for mid-low rectal cancer patients,which can reduce the incidence of anastomotic leak-age after LAR.